Atlantic City

I thoroughly enjoyed a beautiful couple of days on the Atlantic City beach this past week. While it’s now world-famous (or perhaps infamous) for its casinos, there was a time when Atlantic City was famous for its beaches.

Not so long ago (before it descended into the post apocalyptic wasteland that it became in the 1970’s), AC was a favorite seaside destination for my family. I gleefully recall the long trips in my aunt’s blue 1964 Impala down to that mystic city.

Long days on the beach were followed by nights walking the famous boardwalk. I remember the original Steel Pier, the Million Dollar Pier, the Diving Horse, and Mr. Peanut himself hawking his wares.



But, perhaps, the thing that I recall the most clearly were the agonizing trips back home, where my siblings and I, burnt red as lobsters, squirmed and jockeyed to find a comfortable position in that un-airconditioned Impala. A few days after our seashore excursion, our skin would blister and peel off in long sheets and strips.

You see, boys and girls, in the 1960’s, we didn’t use sunscreen. Instead, we used suntan oil, that would magnify and focus the UV rays for maximum impact. Who cared about skin cancer back then – after all, the missiles from Cuba were going to be the death of us all. Let ol’ Sol do his worst.



Today, of course, I slather myself with SPF 50 before venturing out onto the sand. After all, I now know better. Too bad the damage is already done.

Coincidentally, watching the evening news in my hotel room, I was pleased to hear that the FDA had just approved a new drug for treating melanoma. This new miracle drug from Roche, Zelboraf, is particularly effective for patients with certain types of metastatic melanoma. The drug inhibits the cancer-spreading action of a particular gene, which is present in about half of people with metastatic melanoma.

This is, of course, good news for many melanoma patients. The bad news is, unfortunately, this wonder drug costs $9,400 a month (just a smidgeon over $300 a day). For that much money, you can get a beautiful oceanfront suite at an Atlantic City casino. Even if you have health insurance with prescription drug coverage, you’re going to have a tough time getting them to fork over that kind of money every month on your behalf. And most folks would have a tough time (nay, an impossible time) to come up with that kind of scratch each and every month. Even some affluent individuals would have to make sacrifices in order to cover their monthly Zelboraf tab. Conceivably, many will have to sell their pricey shore residences in order to finance their treatment…now isn’t that ironic?




This all begs the question “why does Roche charge do much for this wunder drug? Like the old joke “why does a dog lick his own privates?”, the answer is simple – they can. As the only game in town, patients can now choose the financial misery of Zelboraf or the medical misery of skin cancer.

I guess most of us will have to wait patiently for some competitive products to be approved, or for a generic form of Zelboraf to be released. On that glorious day, the only cancerous mass at the Garden State’s Seashore will be the low-life New York youth that star in a certain television reality show.





Sadly, there doesn’t appear to be any drug on the horizon that will eradicate that particular disease.

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Blackbird Bargains

The SR-71 Blackbird remains the most sophisticated aircraft that the US Air Force ever flew – at least that we know about.

Until it was retired in 1998, the Blackbird spy plane was the fastest thing in the skies. It still holds numerous air speed records, and, at least on one occasion, flew coast to coast in just a hair over an hour. Top that, Southwest. Most experts say that the SR-71 most likely flew even faster than that, but, nearly 15 years after it’s retirement, its top speed remains classified.



Because of the extreme speeds it flew, everything on the plane was designed to deal with the heat that was generated from friction between the airplane and the atmosphere. It was said that the engine oil in the Blackbird, at over $200 a quart, costs more then the finest Scotch Whiskey. Such high operating expense was one of the primary reasons why this super spy plane was retired in 1998.



The SR-71 allowed the US to keep a close eye on our enemies during the Cold War, and there is no doubt that it was instrumental in bringing that terrible phase in world history to an end.

Thank goodness that the engine oil for the SR-71 wasn’t manufactured by the US Pharmaceutical industry – if it were, the Blackbird probably would have ever gotten off the ground.

Tonight, I picked up some prescription eye drops. Even though I have a prescription plan, a 2.5 ml bottle of these drops still cost me a ridiculous $35.00. Yeah, I know that $35 is not a ton of money these days, but this was for a TINY bottle. At this rate, the eye drops cost around $13,250.00 a quart – and that’s with a prescription plan. If I had to pay full price for the drops, the best price I can find on-line was $91 for the same 2.5 ml bottle.. This translates to an outlandish $34,500.00 a quart. Even worse, this is for a .01% solution. So, if I paid retail price for the active ingredient alone, that quart of ‘pure’ eye drops would have set me back almost 3 ½ million dollars a quart.



Which makes the SR-71 engine oil – or the world’s finest Scotch Whiskey – seem like a real bargain after all.

Which is a good thing. After figuring out what these prescription drugs are actually costing us, I think I’m going to need a stiff drink.

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…Comin’ home

I told you so.

The healthcare crisis is slowly rearing its ugly head, and it’s now beginning to adversely affect even those lucky enough to have health insurance from their employers.

The chickens have come home to roost. Don’t say I didn’t warn you.

Here in New Jersey, many people are up in arms about health care. They’re marching on Trenton, holding huge rallies protesting changes in their health plans. Trenton hasn’t seen such an angry mob since George Washing surprised those Hessians on Christmas Eve.



The affected group is comprised of State workers, who are having their health benefit plans changed by the Governor. The Governor has plainly stated that the State just can’t afford to give State workers the fabulous health benefit plan that they have enjoyed for the past many years.

And the workers are pissed. Who can blame them? It was a great plan.


Until these recent changes, the NJ State Benefits plan for State and Municipal employees was fantastic coverage. It covered almost everything, all with little to no expense to the workers. The problem with the plan is that it cost the State around $22,000 a year per person to provide these great benefits. With the current state of the economy, the Governor says that New Jersey just can’t continue footing that health care premium without going bankrupt. So he’s ditching that great plan and making the workers pay a much larger percentage towards their benefits.


This has had two very negative affects on the State employees. First, their contribution towards their health care premium is going to take a big chunk out of their paychecks. They are being offered several plans, none of which are nearly as comprehensive as the old plan. In order to minimize the effect that the new plan will have on their pocketbooks, many are choosing the cheapest plan available. So they are now faced with the reality of paying a big chunk of change for crappy coverage.

And they are pissed off about it. Who wouldn’t be?

Now, adding insult to injury, they are getting even more upset that very few people are sympathetic to their cause. Especially those of us who have already been dealing with this very same situation for many years.

Hey, New Jersey State workers – welcome to our little slice of Hell. Pull up a stool and make yourselves comfortable – chances are we’re all going to be here a while...



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The Magic Word

As a life-long baseball fan, I have a deeply profound appreciation for all of the intricacies of America’s Pastime. As any true fan will tell you, baseball is a sport where the nuances and strategies mean as much as the skills and the physical prowess of the players.

Like all true fans, I am fascinated at the manager’s art, especially when it comes to how they dispute the calls of the umpires. Some managers take a low key approach, while others tend to get right up in the umpires face. Usually, the manager’s intervention has little effect on the umpire, and he returns to the bench without any further ado. However, sometimes the umpire will eject the manager from the game. The fascinating thing is that it’s not just the angry, overtly hostile managers who get ejected – sometimes the mild-mannered ones get tossed as well.



I learned long ago the reason why this happens. It seems that there is a certain ‘magic word’ that the manager (or a player) can use to address the umpire that will ensure his ejection from a game.

Now, being the genteel person that I am, I will not elaborate on the identity of this magic word, but the curious can view the following clip (from one of the greatest baseball movies of all time) in order to gain a clearer understanding of baseball’s magic word phenomena (just make sure that there are no small children, nuns, or prudes around before you play this clip):



http://video.sbrforum.com/video-2424-Bull+Durham+Arguing+with+the+Umpire.html





Baseball is so engrained in our national character that we use many baseball terms to describe everyday events in our daily lives. Phrases like “in the ballpark”, “bush league”, “touch base”, “throw a curveball” .. the list goes on and on. I hereby propose that we add the baseball phrase ‘magic word’ to our national lexicon, and use it to identify a certain phrase that will get you ejected from your doctor’s office.

Now, unless you are a physician, this is not a dirty word – it’s actually quite safe and mundane. You could use it in front of your Mon and she won’t wash out your mouth with soap. But, to physicians, this is the most foul and filthy word in the world.

Want t know what it is? (You know you do!)

It’s iatrogenic.

It’s a Latin word (like all good medical terms) and it means “physician induced” It’s used to describe conditions or diseases that are caused, inadvertently, by medical treatments or procedures.



Our first president, good ‘ol George Washington was a victim of an iatrogenic condition, and it cost him his life. His physicians, in trying to cure his sore throat, used bloodletting on poor George. So zealous were they in their efforts, they accidentally bled the founding father to death, stealing many years off of the end of his life.

Thankfully, modern physicians no longer use bloodletting as a medical procedure. However, they do cause more then their fair share of disease and destruction during the everyday practice od medicine. A disproportionate amount of iatrogenic conditions are the result of, directly or indirectly, prescription medicines.

We’ve all seen the T commercials. The last 10 seconds of almost any T commercial for a prescription drug almost always consists of an announcer calmly listing all the terrible things that can happen to you if you take this particular drug. Still, the consumer is advised to ‘ask your doctor’ about the drug du jour.

Now, the possibility of potentially harmful side effects may be well worth the risk if the drug is designed to save life or limb, but it’s incredible to me how people will risk their well being in taking a drug that promises to cure a inconsequential condition, like yellow toe nails or ‘Restless Leg Syndrome’.

It’s even more incredible how many physicians will support and recommend these drugs in spite of their high risks and low benefits. Physician, after all, are supposed to be guided by the Hippocratic Oath, whose classic translation includes the statement “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect”



I guess that modern version of the oath (which does not include that statement) must have been re-written by Merck.

Even though most patients have never heard of iatrogenic, it is a dirty little secret amongst the medical community. A 2000 presidential report called iatrogenic illness "a national problem of epidemic proportions". The report estimated that iatrgenic disease causes tens of thousands of annual deaths every year, and costs the health care consumer some $29 billion a year. This report is over ten years old, and the figures have not improved with age. Finally, report concludes that half of iatrogenic events are preventable.

Yet, in spite of these staggering and sobering figures, most of us medical muggles have never even heard of iatrogenic disease.

Maybe this is a good thing. Asking your Doctor about iatrogenic disease and iatrogenic drug interactions might just get you kicked out of their office even faster then calling them that other ‘magic’ word.

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The Hole Truth

I’m excited.

I’m just shy of my 10,000th read of this blog. Actually, since I didn’t start using a counter until several months after I started writing the blog, I’m probably well over my 10,000th hit already. However, I’ll stay my celebration until the counter makes it official today or tomorrow.

At this mini-milestone, I am getting reflective as to why I bother to write this. Yes, I’m both passionate and concerned about the current state of health care, but can I really make a difference? Well, maybe, but there are no concrete guarantees that all of this will ever amount to much. So, why do I do it?

I have come to the realization that, like the scorpion on the frog’s back swimming across the stream; it’s just in my nature.

I recall a time 25 years ago when I purchased my first townhouse. It was new construction, and like many things built in the 80’s boom years, it wasn’t built to the highest standards. This was the day of the Yugo, remember.



The townhouse looked real nice from a distance, but it was plagued by a host of quality issues due to poor construction. The first time I turned on my shower, for example, nothing came out – at least out of my shower head. The shower water did pour into my next door neighbor’s living room, however. Not the most ideal way to meet your neighbor, trust me on that. Luckily for me, Sal was a good sport about it – Sal was a tough Italiano who worked on Staten Island in the waste management business. I remember being both upset about my malfunctioning shower and relieved that I wasn’t bathing with the fishes, if you catch my meaning….

Anyhow, the shower incident was just a harbinger of things to come. Everyday, it seemed, my neighbors and I added to our punch list of everything that the builder needed to fix under our homeowner’s warranty. In the meanwhile, the builder dragged their collective feet as they tried to stall us until the warranty expired. It soon turned into a game of wills and wits, with the homeowners pitted against the big corporate builder.


As winter approached, my fellow homeowners all started to voice the same complaint – the units were next to impossible to keep warm. Cold drafts pervaded the units, especially on the second floor. The builder, of course, denied any wrong doing.

One evening, as I sat shivering in my bedroom, I noticed that the drafts seem to emanate from the floor adjacent to the outside wall. In a moment of inspiration, I developed a theory of why we were getting the nasty, unstoppable drafts. The townhouses were designed so that the second stories were actually larger then the ground floors – they cantilevered out about 3 feet on either side. This overhang must not be insulated – Eureka!

The next day, I excitedly called the builder’s office to clue them as to the root cause of the draft problem. Instead of thanking me, they just dismissed my revelation – the units were all properly insulated they assured me. There was no way that the second story overhangs weren’t insulated. When I protested, they explained that I was crazy to think that the builder wouldn’t insulate such a critical area of the townhouse. Besides, the underside of the overhang was already sheathed in aluminum siding, and it would be very expensive and labor intensive to remove that siding just to prove me wrong, so the case was closed – period.

So, my neighbors and I continued to freeze throughout that cold, cold winter, until one night, as I shivered, I had another brilliant revelation – if the builder wouldn’t inspect the overhang space from the outside, I would do it from the inside. Like a man possessed, I grabbed my electric drill, attached a hole saw, and tore back the carpeting in my master bedroom. After cutting a neat 2 inch hole round hole in the floorboards, I shone a flashlight down into the abyss. Shocked but satisfied, I saw nothing in that large open space – except for the underside of the aluminum siding. As I suspected, the entire area was totally uninsulated.



The next morning, I stormed into the builder’s office and tore them a new one. I demanded that the site manager accompany me back to my house and see for himself how my overhang was uninsulated. After sheepishly admitting to their oversight, they got a work crew to come out, remove the siding, and insulate the overhang.

They assured me that this was just an isolated incident.

The insulation refit solved the heating issue in my master bedroom, but then I noticed that the guest bedroom had a similar problem. I asked the builder to please schedule a crew to come out and refit that overhang as well.

“No way” they told me. The master bedroom problem was an isolated incident – there was no way that they were going to tear apart my other overhang just to satisfya draft that surely must exist solely in my imagination. After failing to win that argument with them, I stormed back to my townhouse, got out my hole saw, and repeated my little craniotomy in my guest bedroom floor. No surprise to me – that overhang also had not been insulated either. Another work crew was dispatched to tear apart the overhang in the back of my house.

As the winter progressed, I bragged to my neighbors how my little hole saw brought down the evil empire of Kaplan and Sons. Of course, through chattering teeth, they explained that they had the same cold drafts, and the same cold shoulder given to them by the builder – my unit was an isolated incident, they were told – all the other townhouses in my development were properly insulated.

The revolution started with my neighbor Sal. He asked if I could come over with my hole saw and drill through his floors? Happily, I obliged (Sal, besides being a nice guy, was not the sort of man you refused unless you actually wanted an ice pick in your ear).

Of course, the results were the same in Sal’s townhouse.

Soon, I became the Johnny Appleseed of Belcourt. Have hole saw, will travel. I flitted from unit to unit, drilling holes in many of my neighbor’s floors. I actually never found a single overhang that was insulated. And I drilled enough holes to wear out my hole saw and my drill.

Several months later, my wife and I chanced to walk by a work crew refitting yet another overhang with insulation. After they removed the aluminum fascia, they gazed up at yet another neat 2 inch hole in the floor above their heads. One workman griped – “Yep, the asshole with the hole saw is at it again”. I bit my tongue as I walked past them, but my chest filled with pride.

I was that asshole, and I was damn proud of it.




So may be that’s my motivation for writing this blog. Someday, somehow, I dream of overhearing some CEO of a pharmaceutical company or insurance company referring to me as “that asshole with the blog”.

I know that the chances of this actually happening are between slim and none, but an asshole can dream, can’t he?




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George Carlin

I love oxymorons – two words that are commonly used together but are contradictory in nature. The late, great George Carlin compiled an ever growing list of these couplets, and he would often share them with his audience.

Here are some classic oxymorons:

Jumbo Shrimp
Military Intelligence
Approximately Equal
Constant Change
Industrial Park
Live Recording

Here's some more from the master oxymoronist himself:




Fortunately for oxymoron lovers, the list of these illogical couplets continues to grow. The latest addition to the list comes from our old friends at California Blue Cross/Blue Shield.

I’ve been critical of this company in past blogs, and much of that criticism was the result of their outrageous unfounded rate increases over the past few years. I’m not alone in my disdain for this profiteering company – their rate increases have spawned outrage among their subscribers, journalists, and even the US Congress.

Recently, with their hat in hand, California BC/BS has had a much needed change of heart and has graciously (sic) decided to roll back their rates and even refund some money to their beleaguered subscribers. In addition, California BC/BS CEO Bruce Bodaken has announced that the company will limit its annual net income to no more than 2 percent of revenue.

While this might sound fantastic to some people, to me it just raises a bigger question. You see, California BC/BS is a not-for-profit company,. So what’s all of this talk about income? Isn’t net income just another way of saying profit?

So we have ourselves a new oxymoron – not-for-profit profit.

In addition, the entire press release made no mention of reducing expenditures in order to make their insurance more affordable – they can continue to spend and waste vast sums of money, so long as the ‘net’ profit remains at 2%

Case in point: The top earner at Blue Shield of California was Chief Executive Bodaken, who made $4.6 million last year — which is just a tad more then what you could make flipping burgers at Carl’s Junior. Pundits might argue that his salary is in line with what other insurance executives are making – but they would be wrong. Bodaken’s take home pay was more than four times the salary of his closest counterpart, the CEO if California’s largest for-profit insurer, Anthem Blue Cross.

So the real bottom line here is the same as it is with many other health insurance companies: “Not-for-profit” REALLY means “Not-for-shareholder-profit”. The people who are running these companies are profiting quite nicely from their positions. And the people who are buying their inflated policies and financing their bloated salaries and wasteful spending (like you and I) continue to let them do so.

Which makes all of us Oxymorons. Hold the Oxy.


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